RESUMEN
BACKGROUND: The management of epistaxis requires an understanding of haematological factors that may complicate its treatment. This systematic review includes six distinct reviews examining the evidence supporting epistaxis-specific management strategies relating to warfarin, direct oral anticoagulants, heparin, antiplatelet agents, tranexamic acid and transfusion. METHOD: A systematic review of the literature was performed using a standardised methodology and search strategy. RESULTS: Limited numbers of articles were identified in each systematic review, with level 1 evidence only regarding the use of tranexamic acid. No studies met the inclusion criteria within the heparin, direct oral anticoagulants or transfusion systematic reviews. Many studies were limited by small sample sizes and significant risk of bias. CONCLUSION: The management of major bleeding and transfusion practice is well documented in national guidance from multiple sources. The guidelines include advice on anticoagulants, antiplatelet agents and tranexamic acid. In the absence of more specific evidence, these guidelines should be applied in the management of epistaxis.
Asunto(s)
Epistaxis/sangre , Epistaxis/terapia , Adulto , Anticoagulantes/efectos adversos , Anticoagulantes/uso terapéutico , Transfusión Sanguínea , Epistaxis/inducido químicamente , Medicina Basada en la Evidencia , Adhesión a Directriz , Heparina/efectos adversos , Heparina/uso terapéutico , Humanos , Relación Normalizada Internacional , Tiempo de Internación , Inhibidores de Agregación Plaquetaria/efectos adversos , Inhibidores de Agregación Plaquetaria/uso terapéutico , Ácido Tranexámico/efectos adversos , Ácido Tranexámico/uso terapéutico , Resultado del Tratamiento , Warfarina/efectos adversos , Warfarina/uso terapéuticoRESUMEN
The issues of violence and trauma over the past 20 years have generated a significant amount of research. However, the development of each field has remained, for the most part, exclusive from the other. Therefore, the goal of this article is to address this shortcoming within the literature by responding to three important questions: (a) What is the most important thing we have learned about violence and trauma in the past 20 years? (b) What is the most important thing we need to learn in the next 10 years? and (c) What is the most promising methodological innovation in the past 20 years for the study or treatment of trauma or interpersonal violence? This article concludes that by increasing the discourse between the two fields, both research fields may be better able to develop conceptually, methodologically, and empirically.